Introduction
She had five years of billing experience, all the right certifications, and a resume that made her the easiest yes you’d had in months. Ninety days in, she’s calling in sick more often, claims are backing up again, and you’re starting to wonder if you read her wrong — or if good billers just don’t exist anymore.
You didn’t read her wrong. You hired for the wrong thing.
A Resume Tells You What Someone Can Do. It Doesn’t Tell You If They Actually Want to Do It Here.
Every biller who interviews well can talk about coding, denials, and payer rules — that’s table stakes, and it’s also the easiest thing to check. What almost never gets checked, because it’s much harder to see, is whether someone actually wants the day-to-day reality of the job in front of them, at your practice specifically, rather than billing work in general or a job in general.
That distinction matters more than it sounds like it should. Plenty of experienced billers can do the work competently in an interview scenario and still burn out fast once they’re actually living inside your particular backlog, your particular payer mix, your particular pace. The skill was real. The fit wasn’t. And a mismatch like that doesn’t usually show up as incompetence — it shows up as slow drift: more sick days, more claims sitting untouched, more corners cut, until eventually you’re back where you started, except three months later and out the cost of onboarding.
The Gap Is Almost Never Skill. It’s Whether the Grind Actually Interests Them.
Here’s what actually predicts whether a billing hire sticks: not whether they can do the job, but whether they’re genuinely drawn to the unglamorous middle of it — the fourth resubmission on a stubborn claim, the forty-minute hold with a payer rep, the aging report that needs to be worked line by line, not skimmed. Someone who’s actually built for this work has a real relationship with that part. They don’t tolerate it — they’re satisfied by finally getting a denial overturned after three tries. Someone who’s just good at billing in the abstract, or took the job because it was available, tolerates that grind for a while and then stops.
The hard part is that this almost never shows up on paper, and it rarely shows up in a standard interview either — because everyone knows to say “I love the details” and “I’m very persistent” whether or not it’s true. You can’t ask someone directly if they’re interested in the tedious 80% of the job and expect an honest answer. You have to get at it sideways.
One way to do that: instead of asking about interest, describe an actual situation from your own backlog — a specific denial pattern, a payer that’s been difficult, a claim that’s bounced back twice — and ask the candidate to walk you through how they’d handle it, based on something similar they’ve actually lived through. Someone with real interest in this work gets specific and animated describing that kind of grind. Someone without it stays vague, because they’ve never had a reason to think about it beyond what the job description required.
That one question won’t replace checking someone’s actual billing competence. But it’s the piece most practice owners skip entirely, which is exactly why a hire who looked flawless on paper can still be gone, functionally, within a quarter.
What This Means for Your Next Hire
The next time a billing hire doesn’t work out, resist the instinct to just tighten the resume requirements again. More experience or more certifications won’t fix a problem that was never about capability in the first place. What you’re actually trying to find is someone who’s stayed in billing, by choice, long enough to be genuinely good at the boring parts — not someone who’s simply qualified to do it.
That’s a harder thing to screen for from a stack of applications, which is part of why practices come to us at The Coordinators before a placement ever gets to you. We’re not just confirming someone can do medical billing — we’re confirming they’ve chosen to keep doing it, willingly, for years, because that’s the difference between a hire who lasts and one who looks perfect for ninety days.
